产前皮质类固醇激素给药至分娩的时间间隔对双胎早产儿呼吸系统结局的影响

Effects of the time interval from antenatal corticosteroids administration to delivery on respiratory outcomes in preterm twins

目的评估单疗程产前皮质类固醇激素(antenatal cortiosteroids,ACS)给药至分娩的时间间隔对双胎早产儿呼吸系统结局的影响。方法回顾性分析2018—2019年入住新生儿重症监护室胎龄28 0/7周至346/7周,产母接受单疗程ACS的114例双胎早产儿的临床资料,根据产前末次给予皮质类固醇激素至分娩的时间间隔,分为<7d组(56例)和≥7d组(58例)。对两组的产母特征和新生儿呼吸结局进行比较。结果两组早产儿出生体重、辅助生殖、性别、小于胎龄儿、Apgar评分、产房呼吸支持及产母一般情况方面差异无显著性意义。<7d组早产儿出生胎龄、胎盘绒毛膜羊毛膜炎、新生儿呼吸窘迫综合征(respiratory distress syndrome,RDS)的发生率及机械通气使用率均低于≥7d组,差异有显著性意义(P<0.05)。多因素Logistic回归分析示,胎龄和ACS给药至分娩的时间间隔是RDS发生的独立危险因素。结论单疗程ACS给药至分娩的时间间隔与双胎早产儿的呼吸系统结局有相关性,ACS给药至分娩的时间间隔<7d时可以降低RDS的发病率。因此使用单疗程ACS时应更谨慎,以期在分娩前7天内完成治疗。

Objective To evaluate the effect of time interval from a single course of antenatal corticosteroids(ACS)administration to delivery on the respiratory outcomes in preterm twins.Methods Retrospective analysis was performed on the clinical data of 114 preterm twins,who were admitted to the neonatal intensive care unit of our hospital from 2018 to 2019.The gestational age ranged from 28 0/7 weeks to 34 6/7 weeks,and the pregnant mother received a single course of ACS.They were divided into the<7 days group(56 cases)and the≥7 days group(58 cases)according to the time interval from the last antenatal corticosteroids administration to delivery.Results There were no significant differences between the two groups in terms of birth weight,assisted reproduction,sex,smaller-gestational age,Apgar score,respiratory support in delivery room and maternal general condition.The preterm gestational age,placental chorioamnionitis,incidence of neonatal respiratory distress syndrome and the utilization rate of mechanical ventilation in the group<7 days were all lower than those in the group≥7 days,the differences were significant(P<0.05).Multivariate Logistic regression analysis revealed that gestational age and the time interval from ACS administration to delivery were independent risk factors for RDS.Conclusion The time interval from a single course of ACS administration to delivery is associated with the respiratory outcomes in preterm twins,the time interval from ACS administration to delivery<7 days can reduce the incidence of RDS.Therefore,more caution should be exercised in the use of a single course of ACS,with a view to completing treatment within 7 days before delivery.